Alessandria Carlo, Venon Wilma Debernardi, Marzano Alfredo, Barletti Claudio, Fadda Maurizio, Rizzetto Mario
Department of Gastroenterology, San Giovanni Battista Hospital, Torino, Italy.
Eur J Gastroenterol Hepatol. 2002 Dec;14(12):1363-8. doi: 10.1097/00042737-200212000-00013.
Renal failure secondary to hepatorenal syndrome or to organic renal disease occurs frequently in cirrhotic patients with portal hypertension. The present prospective study investigates the usefulness of terlipressin in both the diagnostic and the therapeutic approach to cirrhotics with renal failure.
Sixteen patients were studied: 11 with hepatorenal syndrome type 2 (group 1) and five with organic renal disease (group 2). All received terlipressin (1 mg/4 h intravenously) for 7 days. Subsequently, 12 patients (nine from group 1 and three from group 2) underwent a transjugular intrahepatic portosystemic shunt.
Terlipressin significantly improved renal function (serum creatinine, 1.8 +/- 0.8 versus 2.4 +/- 0.9 mg/dl; blood creatinine clearance, 53 +/- 8 versus 21.3 +/- 8.7 ml/min; P < 0.05) in group 1 [8/11 patients (73%) versus 1/5 (20%) of group 2; P < 0.05]. The only patient in group 2 who responded to terlipressin had a mixed renal dysfunction. Renal function improved significantly after transjugular portosystemic shunt in all patients who responded to terlipressin.
Terlipressin administration significantly improves renal function in cirrhotic patients with hepatorenal syndrome type 2 but not in organic kidney failure. By providing the critical information that a patient's kidney function is (or is not) reversible, a trial with terlipressin may be useful when selecting cirrhotic patients with renal failure as candidates for a transjugular intrahepatic portosystemic shunt or liver transplantation.
肝肾综合征或器质性肾病继发的肾衰竭在门静脉高压的肝硬化患者中频繁发生。本前瞻性研究探讨特利加压素在肝硬化合并肾衰竭患者的诊断和治疗方法中的作用。
对16例患者进行了研究：11例为2型肝肾综合征患者（第1组），5例为器质性肾病患者（第2组）。所有患者均接受特利加压素（1毫克/4小时静脉注射）治疗7天。随后，12例患者（第1组9例，第2组3例）接受了经颈静脉肝内门体分流术。
特利加压素显著改善了第1组患者的肾功能（血清肌酐，1.8±0.8对2.4±0.9毫克/分升；血肌酐清除率，53±8对21.3±8.7毫升/分钟；P<0.05）[第1组8/11例患者（73%）对第2组1/5例患者（20%）；P<0.05]。第2组中唯一对特利加压素产生反应的患者有混合性肾功能障碍。在所有对特利加压素产生反应的患者中，经颈静脉门体分流术后肾功能显著改善。
给予特利加压素可显著改善2型肝肾综合征肝硬化患者的肾功能，但对器质性肾衰竭患者无效。通过提供患者肾功能是否可逆的关键信息，在选择肝硬化合并肾衰竭患者作为经颈静脉肝内门体分流术或肝移植候选者时，特利加压素试验可能有用。
